Palliative care phases

In PCOC, a palliative care phase describes a stage of the patient’s illness within an episode of care and provides a clinical indication of the level of care required. There are 4 palliative care phases used in PCOC—stable, unstable, deteriorating and terminal. When assigned, the first three phases reflect the effectiveness of the plan of care and the urgency of response to patient and family care needs. The terminal phase is assigned when the patient is likely to die within days. It should be noted that palliative care phases are not necessarily sequential: the patient may transition back and forth between phases during an episode and there is also likely to be more than one phase of care within an episode.

There were 138,364 palliative care phases reported to PCOC in 2018, with just under half (48.2%) occurring in inpatient palliative care. Of these, just over one-third (33.4%) were in a deteriorating phase followed by stable (25.0%) and terminal (21.3%) phases. Of the 71,700 phases reported in the community care setting, 42.2% were in a deteriorating phase, followed by stable (37.5%) and unstable (12.6%) phases (Figure PCOC.5).

For both the inpatient and community care settings, the average phase length (elapsed days) was highest for the stable phase (at 7.0 days and 21.5 days respectively), followed by the deteriorating phase (6.3 days and 14.4 days respectively) and the terminal phase (2.1 days and 3.7 days respectively).

 

Figure PCOC.5 Alternative text - Source data: Palliative care outcomes tables (429KB XLS)

Palliative care outcome measures and benchmarks

In 2009, PCOC and participating services, developed and implemented a set of national outcome measures and associated benchmarks to drive service innovation and allow participating services to compare their service nationally. These outcome measures cover:

  1. time from date ready for care to episode start (Benchmark 1)
  2. time patient spent in an unstable phase (Benchmark 2)
  3. change in symptoms and problems (Benchmark 3).

In 2015, six additional measures relating to fatigue, breathing problems and family/carer problems were introduced. A full description of each of the PCOC benchmarks reported here is shown in Table PCOC.13. PCOC also reports on 8 casemix adjusted outcomes measures, not reported here.

Based on PCOC palliative care outcome benchmark results, in general, patients receiving inpatient (hospital/hospice) care are more likely to achieve better outcomes than patients receiving care at home (Figure PCOC.6). Research conducted by Eager, Clapham and Allingham (2018) found that around 85% of palliative care patients had no severe symptoms prior to death, and hospital patients were 3.7 times more likely to have no severe symptoms than patients at home.

A high proportion of all patient episodes (94.2%) had care start within two days of the patient being ready (benchmark 1) whilst 87.9% of patients spent 3 days or less in the unstable phase (benchmark 2). Positive outcomes were achieved for 94.0% of patients beginning a phase with absent to mild breathing problems (benchmark 3.7).

The majority of patients experience no more than absent or mild symptoms or problems. For those patients who did experience moderate to severe distress from fatigue, 43.7% had this reduced to absent or mild (benchmark 3.6). Similarly, moderate to severe distress from breathing problems was reduced to absent or mild for 45.9% of patients (benchmark 3.8). Over half (55.9%) of patients who began experiencing moderate to severe distress from pain had this improved to absent/mild (benchmark 3.4). Achieving an absent/mild symptom (or problem) outcome is less likely when the patient has moderate or severe symptoms (or problems) to begin with as is reflected in the outcome results.

 

Figure PCOC.6 Alternative text - Source data: Palliative care outcomes tables (429KB XLS)

References

ABS (Australian Bureau of Statistics) 2017a. 2016 Census: Multicultural (media release).  Canberra: ABS.

ABS 2017b. Migration, Australia, 2015–16. ABS cat.no. 3412.0. Canberra: ABS.

ABS 2018a. Estimates of Aboriginal and Torres Strait Islander Australians, June 2016. ABS cat. no. 3238.0.55.001. Canberrra: ABS.

ABS 2018b. Socio-Economic Indexes for Areas. Canberra: ABS. Viewed 7 May 2019.

Eagar K, Clapham SP, Allingham SF 2018.  Palliative care is effective: but hospital symptom outcomes superior.  BMJ Supportive & Palliative Care. 31 August 2018. doi: 10.1136/bmjspcare-2018-001534.

Alternative text for PCOC figures

Figure PCOC.1

Vertical bar chart showing the per cent of PCOC palliative care episodes by age group and setting. Inpatient and community settings respectively <25 0.2, 0.5; 25—34 0.8, 0.8; 35—44 2.3, 2.1; 45—54 6.1, 6.5; 55—64 15.6, 15.1; 65—74 25.3, 24.7; 75—84 27.7, 27.4; 85+ 21.1, 22.9. Refer to Table PCOC.11. Back to Figure PCOC.1

Figure PCOC.2

Vertical bar chart showing the per cent of PCOC palliative care episodes by socioeconomic status (IRSAD quintile), for inpatient and community care settings. Quintile 1 15.7 (inpatient), 16.2 (community); quintile 2 14.9, 12.9; quintile 3 20.0, 18.6; quintile 4 21.6, 21.5; quintile 5 27.8, 30.8. Refer to Table PCOC.6. Back to Figure PCOC.2

Figure PCOC.3

Vertical bar chart showing the per cent of PCOC closed episodes by number of elapsed days, for inpatient and community care settings. <1 6.8 (inpatient), 2.9 (community); 1–2 days 20.0, 6.5; 3–4  14.7, 6.0; 5–7 17.1, 8.0; 8–14 20.1, 13.1; 15–21 9.2, 9.4; 22–30 5.9, 8.9; 31–60 5.1, 16.8; 61–90 0.8, 8.9; >90 0.3, 19.5. Refer to Table PCOC.8. Back to Figure PCOC.3

Figure PCOC.4

Horizontal line chart showing the number of closed episodes by palliative care setting from 2014 to 2018. 2014 23,192 (inpatient), 18,690 (community); 2015 25,070, 21,102; 2016 26,592, 20,726; 2017 28,137, 22,953; 2018 28,759, 24,649. Refer to Table PCOC.7. Back to Figure PCOC.4

Figure PCOC.5

Vertical bar chart showing the per cent of phase counts by palliative care phase by inpatient and community setting. Stable 25.0% (inpatient), 37.5% (community); unstable 20.3, 12.6; deteriorating 33.4, 42.2; terminal 21.3, 7.7. Refer to Table PCOC.9. Back to Figure PCOC.5

Figure PCOC.6

Vertical bar chart showing PCOC palliative care outcome benchmark results, by inpatient and community care settings. Benchmark 1 98.3 (inpatient), 89.3 (community); Benchmark 2 89.7, 84.9; Benchmark 3.1 92.1, 85.5; Benchmark 3.2 63.8, 58.2; Benchmark 3.3 91.1, 84.4; Benchmark 3.4 59.0, 52.7; Benchmark 3.5 90.9, 80.1; Benchmark 3.6 53.8, 36.5; Benchmark 3.7 95.5, 92.7; Benchmark 3.8 53.0, 39.1; Benchmark 3.9 93.4, 84.0; Benchmark 3.10 55.4, 49.1. Refer to Table PCOC.13. Back to Figure PCOC.6